Plasmodium vivax Malaria–associated Acute Kidney Injury, India, 2010–2011

Vivek B. Kute

, Hargovind L. Trivedi, Aruna V. Vanikar, Pankaj R. Shah, Manoj R. Gumber, Himanshu V. Patel, Jitendra G. Goswami, and Kamal V. Kanodia

Author affiliations: Institute of Kidney Diseases and Research Centre–Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India

Abstract

Plasmodium vivax is causing increasingly more cases of severe malaria worldwide. Among 25 cases in India during 2010–2011, associated conditions were renal failure, thrombocytopenia, jaundice, severe anemia, acute respiratory distress syndrome, shock, cerebral malaria, hypoglycemia, and death. Further studies are needed to determine why P. vivax malaria is becoming more severe.

India is a major contributor to the worldwide distribution of Plasmodium vivax malaria (1). Severe and complicated malaria is usually caused by the P. falciparum parasite, but P. vivax, usually considered a benign parasite that causes disease resulting in low case-fatality rates, can also occasionally cause severe disease. Reported severe manifestations of P. vivax include cerebral malaria, liver dysfunction, acute kidney injury, severe anemia, acute respiratory distress syndrome, shock, abnormal bleeding, and multiple organ failure (2–10). The mechanism of P. vivax–associated acute kidney injury and its effective management remain unclear. In addition, little information is found in the literature to explain the recent increase in incidence of acute kidney injury and the shift toward multiple complications, specifically in India (11). This scarcity of data prompted us to review cases at the Institute of Kidney Diseases and Research Centre–Institute of Transplantation Sciences, Civil Hospital, Ahmedabad, India.